Comparative Effects of Mirtazapine and Fluoxetine on Sleep Physiology Measures in Patients With Major Depression and Insomnia

Andrew Winokur, M.D., Ph.D.; Nicholas A. DeMartinis III, M.D.; Daniel P. McNally, M.D.; Ellen M. Gary, B.S.N.; Jennifer L. Cormier, M.S.; and Keith A. Gary, Ph.D.

Background: Sleep complaints are common in patients with major depressive disorder (MDD). Both MDD and antidepressant drugs characteristically alter objective sleep measures. This study compares the effects of mirtazapine and fluoxetine on sleep continuity measures in DSM-IV MDD patients with insomnia.

Method: Patients (N = 19) received initial baseline polysomnography evaluations over 2 consecutive nights. Subjects were randomly assigned to either fluoxetine (20-40 mg/day) or mirtazapine (15-45 mg/day) treatment for an 8-week, double-blind, double-dummy treatment trial. Single-night polysomnograms were conducted at weeks 1, 2, and 8, with depression ratings assessed at baseline and weeks 1, 2, 3, 4, 6, and 8. Statistical analysis was performed by repeated-measures analysis of variance followed by Dunnet's post hoc analyses.

Results: Patients receiving mirtazapine (N = 8) had significant improvement in objective sleep physiology measures at 8 weeks. Improvements in sleep latency, sleep efficiency, and wake after sleep onset were significant after only 2 weeks of mirtazapine treatment. No significant changes in sleep continuity measures were observed in the fluoxetine group (N = 11). Both groups improved clinically in mood and subjective sleep measures from baseline, with no differences between groups.

Conclusion: These data demonstrate the differential effects of mirtazapine and fluoxetine, with significant improvement in favor of mirtazapine, on objective sleep parameters in MDD patients with insomnia.

(J Clin Psychiatry 2003;64:1224-1229)

Received Aug. 30, 2002; accepted April 8, 2003. From the Neuropsychopharmacology Treatment, Research, and Training Center, Department of Psychiatry (Drs. Winokur, DeMartinis, and Gary and Mss. Gary and Cormier) and the Pulmonary/Critical Care Division, Department of Medicine, University of Connecticut Health Center, Farmington.

Funds for this study were provided through an unrestricted educational grant from Organon, Inc.

Dr. Winokur has received grant/research support from Organon, Merck, and GlaxoSmithKline and has been a speakers or advisory board member for Cephalon, Pfizer, and Bristol-Myers Squibb. Dr. DeMartinis has been a consultant for Pfizer and Eli Lilly; has received grant/research support from Pfizer, Merck, Pharmacia, GlaxoSmithKline, Wyeth, and Organon; and has been a speakers or advisory board member for Wyeth, Pfizer, Lilly, GlaxoSmithKline, AstraZeneca, and Forest.

Corresponding author and reprints: Andrew Winokur, M.D., Ph.D., Department of Psychiatry, University of Connecticut Health Center, Talcott Notch Road, Farmington, CT 06030-6415 (e-mail: winokur@psychiatry.uchc.edu).